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What is the impact of capping ?

QuestionsCategory: Group Health InsuranceWhat is the impact of capping ?
default avatarPlan Cover Staff asked 3 months ago

1 Answers

Best Answer

default avatarSrinivasan Mahadevan Staff answered 3 months ago
Impact of capping it reduce the cost of premium in the health insurance and also maintains the claim ratio in the insurance policy.

Capping amount will be decided at the time of inception of the policy there are types of the capping room rent capping,diseases wise cappings,at the time of claim capping will be applied as per policy room rent capping is there then capping amount will be followed by the insured if as per policy room rent is capped with the 1% of the sum insured per day for normal room and 2% of the sum insured for ICU and the sum insured is 3 lakh per person then 3K per day room can be avail for normal room rent and 6k for ICU per day will be paid for a claim. Disease Wise Capping:- Disease wise capping means only capped or restricted amount will be paid Disease are not specified and vary depending on the specific T&C of your Policy plan.But some Standard health insurance policies has disease which are by defult in the policy plan. Cataract, Hernia,Calculus,Piles. Capping on maternity Cost :Maternity is normally not covered and has a waiting period of 9 months and claim from Day1 is not possible. Some Policies have a 3-year waiting period or lesser. The logic is that from the date of inception of the Policy,maternity coverage is not possible and therefore it varies from policy to policy. 9 month waiting period means that if there is a claim in this period it will not be covered. However, for Group Insurance wherever we pay an extra loading on the premium – this 9-month waiting period is waived off Normally standard limits for C Section and Normal deliveries are not specified and vary depending on the specific T&C of your Policy. Normal Cost are always lesser as Hospitalisation is limited to 1-2 days only. C Section deliveries are those where there is a surgery involved in the delivery process.

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